At this special time of the year, I offer a message of Christmas cheer to nine of our nation's Governors. This is not random pick. These are the nine who have declared they will not allow their respective states to participate in the expansion of Medicaid to all their states' uninsured residents with incomes below 133% of the federal poverty line, beginning on January 1, 2014. Merry Christmas!

Under the Affordable Care Act/Obamacare, all states were required to participate in this expansion. The U.S. Supreme Court ruling, this past June 28, made the Medicaid expansion an option for states to decide. According to the survey conveyed in the map below, 9 Governors have decided no, 5 are leaning no, 5 are leaning yes, 14 are definite yes, and 17 are still undecided. Here I want to focus on the 9 definite nos.

In the wake of the shootings in Newtown Connecticut, it has been encouraging to hear so many calls for attention to improving mental health services in the U.S. Like oral health, mental health is a poor step-sister in our nation's behemoth health care system, mostly on the outside, shouting for attention, and having to settle for second class.

So it's good to hear voices saying we have to do better.

Here's a question: regarding U.S. mental health policy, what's the most important and consequential federal legislation ever signed into law?

Answer: the Affordable Care Act, also known as the ACA and Obamacare. Hardly anyone appreciates the enormous advance in mental health policy created by the ACA, and it's true.

In addition to the Newtown CT horror, this weekend I unexpectedly learned of two other instances of incomprehensible inhumanity to children. Contemplating all three puts Newtown in a different light:

First, on Friday morning, I heard NPR's Sylvia Poggioli report that for more than 40 years in Spain, between 1939 and the early 1980s, a secret network of Catholic nuns, priests and physicians, supported by the fascist government of Frederico Franco, abducted as many as 300,000 newborn infants from low-income and leftist mothers and sold them for adoption to conservative and church-going families. Here's a riveting BBC story from last year on the same topic.

As Congressional Republicans concede to the inevitability of higher tax rates on the nation's wealthiest 2%, the chorus for "entitlement reform" grows steadily, especially in Medicare. Though Republicans have been timid to state their Medicare agenda in public (Cong. Paul Ryan's voucher/premium support plan doesn't count because it would only take effect in 2022), the idea to raise the age of eligibility from 65 to 67 to enroll in Medicare is gaining traction. Some reports suggest that President Obama may be open to an "avoid the fiscal cliff" deal that includes this element.

Many media commentators seem warm to the idea. So let's consider whether this is a good idea or a bad one.

During the campaign, candidate Romney repeatedly hammered President Obama for cutting $716 billion from Medicare as part of his signature healthcare law. Romney pledged to repeal those cuts in a break from his running mate, Rep. Paul Ryan (R-Wis.).

Ryan, the House Budget Committee Chairman, had preserved Obama's Medicare cuts in two consecutive budget proposals that repealed the rest of the Affordable Care Act. Ryan is now back at work crafting his next budget, and Republicans on his committee say the $716 billion in Medicare cuts will likely survive.

Rep. Rob Woodall (R-Ga.) said the $716 billion cut is part of the committee's over-arching plan to save and reform Medicare. He said he doesn't expect Ryan to back away from any part of that goal just because Romney was on a different page.

I have written numerous times about the Medicare savings/reductions in the Affordable Care Act, here, here, here, and here, for just a few. To appreciate the scope of this hypocrisy, bear with me.